Soru

A 54-year-old man presents to the emergency department with a 12-hour history of severe, cramping abdominal pain and frequent vomiting. He has not had a bowel movement or passed flatus since the onset of his symptoms. His surgical history includes an open cholecystectomy performed 15 years ago. Vital signs show a temperature of 37.2°C (99.0°F), pulse of 98/min, respirations of 18/min, and blood pressure of 130/80 mm Hg. On physical examination, the abdomen is moderately distended and tympanic to percussion. Auscultation reveals high-pitched, hyperactive bowel sounds. There is moderate diffuse tenderness on palpation, but no guarding, rigidity, or rebound tenderness is appreciated. Laboratory investigations show a leukocyte count of 9,500/mm³ and a serum lactate level of 1.2 mmol/L. Cross-sectional imaging of the abdomen with intravenous contrast demonstrates multiple dilated small bowel loops measuring up to 4.5 cm in diameter. Furthermore, a cluster of U-shaped, fluid-filled bowel loops is identified in the mid-abdomen, with the associated mesenteric vessels radially converging toward a central focal point. The bowel wall enhancement is uniformly preserved, and there is no evidence of pneumatosis intestinalis or free intraperitoneal air. Which of the following is the most appropriate next step in the management of this patient?